COVID-19 Outbreak Update

COVID-19 Outbreak Update

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Public Health Threats and Pandemics

CFR fellows discuss updates on the COVID-19 (coronavirus) pandemic, including its effects on health systems and the global economy.


Thomas J. Bollyky

Senior Fellow for Global Health, Economics, and Development and Director of the Global Health Program, Council on Foreign Relations; Managing Editor, Think Global Health;@TomBollyky

Yanzhong Huang

Senior Fellow for Global Health, Council on Foreign Relations;@YanzhongHuang

Sebastian Mallaby

Paul A. Volcker Senior Fellow for International Economics, Council on Foreign Relations; @scmallaby


Richard Haass

President, Council on Foreign Relations; @RichardHaass

HAASS: Thank you, Ryan, and good afternoon to most of you. It might be good morning or good evening to a few. Thank you for joining us today on this, the latest of our conference calls here at CFR.

Today we’ve got a range of expertise. We’ve got Tom Bollyky, who is our senior fellow here at the Council on Foreign Relations who deals with all things public and global health.

(Background noise.) We’ve got all sorts of noise on the background somewhere. I apologize for that.

But Tom oversees the Think Global Health site, as well as, again, leading experts in the country on global health.

Secondly, we’ve got Yanzhong Huang, who’s also a senior fellow here at the Council on Foreign Relations, who’s an expert in things China—Chinese public health, the relationship between Chinese environmental policy and its public health.

And last and not least we have Sebastian Mallaby, who oversees a lot of our work on international economics at the Council on Foreign Relations. Sebastian also has the—we’ll call it the reality rather than advantage or disadvantage of living most of the year in the U.K., so I will ask him to also opine a bit about things U.K.

We will talk amongst ourselves for about the next twenty-five minutes, just to warn you, and then we’ll save roughly half our time for your questions. And at that point, around half past the hour, I’ll ask Ryan to explain the ground rules.

So let me begin with Tom Bollyky just so we’re all contextualized, so to speak. Tom, why don’t you just sort of set the stage. Here we are. It is March 23. Where are we right now in terms of this crisis, both globally as well as in the United States?

BOLLYKY: Great. I think it’s fair to say at this point no country is going to escape this pandemic. In many ways, every nation is somewhere on the same epidemic curve together. That’s become clear, really, over the last month. Over the last month 110—roughly 110 countries have announced their first case of the—of the novel coronavirus, the disease that’s referred to as COVID-19. We are now at 315,000 cases globally. Most of the cases that have been the first cases for most nations have no longer—no longer are directly coming from China.

At this point it’s clear that Europe is the epicenter of the pandemic currently, with Italy reporting sixty thousand cases, Spain reporting thirty-three thousand cases, but every country really grappling in the midst of this—of this pandemic.

North America and the U.S. in particular are not far behind. It wasn’t too long ago—on March 2, three weeks ago—that the U.S. only reported eighty-seven reported cases of COVID-19. We are now reporting thirty-three thousand just three weeks later, and that puts us as the country with the third-most COVID-19 cases globally.

We’re seeing increasing spread, though, in Latin America. Sub-Saharan Africa now has thirty-four countries with cases of COVID-19. Syria reported its first case today, and that has many people concerned as it’s one of the most challenging health environments.

It’s going to be important when we look at the U.S. to look to what’s happening abroad for countries ahead of us and behind us in terms of anticipating what—which policies are most likely to work in this context, and what awaits us, and what the longer-term consequences of this pandemic might be.

HAASS: Thank you, Tom.

Just to let people know, by the way, this Wednesday from two to three p.m. we’re going to have a conference call specifically devoted to the situation in Europe, and the week after we’re going to have a conference call specifically devoted to the situation in the Middle East, and we’ll make this a pattern of doing—once a week or so doing a regional focus.

Tom, say a little bit more about one thing. In the last twenty-four hours you seem to have had a slight change in the debate. Up to now you’ve had a lot of emphasis—and it continues—on closing off the United States, a lot of emphasis on the short of PPE, of ventilators, the inadequacy of testing, an uneven application across the country of social or physical distancing. And then in the last twenty-four hours, on top of all this, you’ve had a slight twist in the conversation with the president tweeting we have to be careful that the cure isn’t worse than the disease and a number of articles in today’s papers, including one by Tom Friedman in The New York Times—I think I saw another one in The Wall Street Journal; I could get my newspapers mixed up—essentially saying I guess the word of the day became surgical instruments rather than blunt instruments. Would you please just tee up that conversation a little bit so we all understand it better?

BOLLYKY: Sure. So the debate is there’s really two approaches countries have taken, two broad buckets of approaches countries have taken in response to this virus. So far 100 percent of the countries have been effective have all been effective largely in the same way. They have aggressively tested for the presence of the virus. They have isolated those with that—were confirmed with infection, traced their contacts, adopted quarantine and broader social-distancing measures. There’s some nuances around that approach. Some tested more asymptomatic people. Some adopted stronger measures in terms of social distancing. But they’ve all largely followed the same approach. In this bucket I would put Singapore, Taiwan, South Korea, alternately in the later stages of the outbreak China.

Then there’s the rest of the world, including what’s happening in Italy and what’s happening in the United States, which is that the outbreak—or, the virus takes hold, you have community transmission. It’s no longer possible just through testing and tracing to track and control the virus. And it’s a matter of adopting blunter instruments that will be effective, even if you do not know whether or not individuals have the virus. And that’s what we’re seeing in the United States, where the slowness in rolling out testing has meant that we have had to adopt, for much of the country, very strong measures to reduce or suppress the spread of the virus. So South Korea—to give you an example the differences in degrees—South Korea tested 320,000 people. On a per capita basis, that’s a rate thirty times higher than what we’ve done so far in the United States. So in particularly U.S. communities that have community spread—like New York City, like Washington state, like parts of California, and maybe more, this is no longer an option to us.

In terms of the broader debate, is this shutting down of the economy shutting down of social life, worth it? And here, I would just point out to the listeners that this is—what we’re seeing today in the United States reflects what happened three weeks ago with this virus. That’s because the health care demands lag the new infections by about two to three weeks. It takes that long for a newly infected person to get critically ill. Let’s talk about where Italy was there weeks ago. Three weeks ago, Italy had—was reporting just under 1,700 cases and just thirty-four deaths. Over the weekend alone, Italy reported close to or more than 1,400 deaths, for now a total of close to 5,500. And they have sixty thousand confirmed cases. Italy has a case fatality rate, so deaths per number of cases right now, that’s over 8 percent. Now, that reflects the elderly population, but it also—in Italy—but reflects a very overwhelmed health system.

Let’s talk about just where New York City is today. New York City has a population that is a little lower than what you have in the Lombardy region of Italy, which is ten million. New York is about eight-point-five million. New York right now has twelve thousand—more than twelve thousand cases. We have fewer number—New York City has fewer number of hospital beds than Italy. We’ve done significantly less testing, so people think that the reality is the numbers are going to be higher in terms of number of people with the virus. What is New York going to look like in three weeks if Italy looks like now what it’s going through in response to where they were three weeks ago.

So I think the reality in the debate over the cure being worse than the disease, the disease is going to be pretty bad. Anything we can do to reduce the severity is going to be important. But we should also keep in mind that if this does proceed the way it has in other nations, you’re likely to see people engaging in many of these social distancing policies on their own. What we have an opportunity to do now with public health measures is try to encourage that early so it’s as effective as possible, rather than lagging the outbreak, which is ultimately what happened in Italy and contributed to their terrible situation. And let me—let me stop there.

HAASS: Thank you, Tom.

Yanzhong, why don’t you say something—I know you have views also about this question of a more focused response and emphasizing those with preexisting conditions, be it the elderly and so forth, rather than such a—rather than, if you will, going the path of a blunt, societal-wide response. Why don’t you address that? And then I’ll ask you a question about China.

HUANG: OK, sure. Yeah, I think that when we are making this decision on how to respond—how a community is responding to the outbreak, I think a sound government response is not about making a choice between, like, maximum protection of health and minimum disruption to economy and the society. It’s always about, you know, carefully balancing and managing health risks, and keeping the economy and society afloat. And so I think China certainly provides a very unique approach on how to address the outbreak.

But as Tom just mentioned, Singapore, South Korea, and Taiwan provide a slightly different approach because while aggressive in terms of dealing with the outbreak, they also tried to minimize the potential disruption to the economy and the society, which is very—like, in China, where essentially they are pursuing approach that tried to bring down the cases at all cost. And in doing so, I think for Western countries it’s also important, if we are considering this evidence-based decision making, that this elderly population should be—I think if we are adopting a strategy of mitigation, it’s important to focus the resources on this segment of the population.

HAASS: Can you say something then more broadly about China, which is: Where is it right now in terms of the health challenge—we’ve seen all sorts of things about essentially disappearance, or relative disappearance, of new cases—where they are economically, and what all this means for the political leadership. To what extent is the political leadership—have they turned—how would I put it? I don’t mean to be trivial here. They’ve turned lemons into lemonade, that despite a very, very slow and bad start, and a coverup for several weeks, that right now the Chinese leadership may ironically enough, or whatever the world is, be stronger rather than weaker because of the experience of the last three months?

HUANG: Absolutely. Yeah. For more than two months, maybe one month ago, we were still talking about, you know, how the coronavirus outbreak could pose a serious challenge to President Xi’s legitimacy and leadership capacity. But now we know that China has officially, since beginning March 19, zero new cases. Although, they created this different category, imported cases, as well as those without symptoms. You know, that’s not counted as new cases. So they are declaring that China has not had any new cases since March 19. And the production has also been—they have resumed production now. And it seems that the—according to the official statistics—about 80 percent of the production has been—factories has been—has resumed production.

And I think that is considered a victory of President Xi. Not only because he muddled through the crisis, but also he could point to actually effective means of the Chinese approach by claiming that the Chinese draconian approach presents a viable alternative to the disease—to the coronavirus prevention control. Indeed, the WHO—a leading expert of WHO said that the Chinese—other countries should replicate the Chinese model. And in the meantime, there’s all this talk about the joint lessons from the crisis, like, becoming more transparent. You know, these voices have essentially been silenced because of the crackdown on the social media. And in the meantime, the Chinese leadership could point to the rapid prevention and proliferation of cases, and the deaths—rise in numbers, you know, in Western countries, you know, saying how effective, you know, the Chinese approach is.

So all this—you know, according to the Chinese diplomats and leaders—demonstrates the superiority of the Chinese model. So President Xi not just has already, I think, muddled through the crisis, he’s emerged as a winner in this game.

HAASS: It’s hard to ignore the irony of that, or worse, given how it’s not simply that the virus broke out in China, but the initial few weeks of Chinese response dramatically contributed to the challenge that not just they, but everyone else now faces. But there you have it.

Sebastian, let’s focus on the economic side. Let’s begin almost with the economic equivalent to where I began with Tom. What’s the state of play around the world as you—as you see it? And would you, like some people, use the D-word, the “depression” word, or is that premature or an exaggeration?

MALLABY: Well, let’s start with the nature of the response, Richard. I think that the exponential growth in the number of cases is only a bit more amazing than the exponential growth in the amount of economic policy response.

To give you just one metric of that, the U.S. Federal Reserve is promising larger asset purchases this week than it did during an entire program of quantitative easing that lasted for eight months in 2010-2011. So the mantra that policymakers took away from the 2008 crisis, which was whatever it takes, go in there with a bazooka, if you project overwhelming force people will have confidence that you’re going to win and that confidence will be in some sense self-fulfilling in protecting economies against—D-word—depressions, that whatever-it-takes mentality is really driving the response. And today’s action by the Fed is one example. Central banks elsewhere—in Europe, in the U.K., and Japan—have been extremely aggressive as well.

And increasingly we’re seeing an enormous fiscal response much, much quicker in terms of budget spending than you had back in ’08. There has been no moment equivalent to the Lehman Brothers weekend where policymakers sort of hesitated and did not throw money at the problem. There’s just been money that looked big followed by even more money that looks even bigger, and so that’s clearly the mentality.

I think it’s worth pointing out that although the response is very much informed by that 2008 mentality, there are really three differences between this challenge and the one in ’08. Two of those differences make today’s thing look more worrying, and one of them is positive.

So the first difference—and this gets to your question about the possibility of depression—is that the short-term economic disruption looks like it’s going to be bigger this time, if you can believe that, than the post-Lehman Brothers contraction. I saw that Morgan Stanley predicted a 30 percent contraction year-on-year in U.S. GDP—30 percent, so an incredibly sharp fall. Now, that’s a forward-looking projection for the second quarter of this year, but if we do backward-looking and we look at January/February, what happened in China is the Chinese industrial production down 13.5 percent year-on-year and an expected contraction in GDP of about 10 percent. This is the worst since the Cultural Revolution in China, so these are very, very stark numbers, worse even than in 2008.

Second difference between now and 2008 is that that time in ’08 was purely a demand shock. People suddenly didn’t have money to spend and the financial system froze up. This time you also have a supply shock because workers are being prevented from going to work. Some of them are going to be sick. Supply chains are going to be massively disrupted. Transit across borders is difficult. And so that’s going to mean that, as well as demand management where you basically pump money into the economy to prop up demand in spending, you’re going to have to do some supply management. And that could vary from the armed forces in Italy helping private-sector manufacturers to supply critical goods like ventilators to potential rationing of food or other goods where there are supply-chain disruptions.

And then, thirdly, the difference which is on the optimistic side is that this is not a balance-sheet recession that we’re going into. ’08 you had this sudden decline in real-estate values and in the value of all financial instruments that were linked to real estate, and that was a huge chunk of financial-market activity. And that meant that you had people’s wealth go up in smoke, and that has a lasting effect on spending. There’s a big debt overhang that you’re left with. And so you get this sort of very gradual, painful recovery from the recession. This time the shock originates in the drying up of immediate income. Workers can’t go out and work, and some of them will lose their jobs or if they’re freelancers they won’t get paid. Similarly, corporations have had to close down if they’re in the retail sector, the airline sector, what have you. And so suddenly income is collapsing. Now, on the back of that you’re seeing the stock market collapse. You’re seeing a lot of selloff in bond markets. So of course, there’s a knock-on effect for asset prices. But my point is that the origin of the crunch is on the income side, not the asset side, and that’s where, you know, once people can go back to work you should see a pretty sharp recovery. So very sharp downturn now, but it will ultimately be a V-shaped recovery when we finally get through the pandemic.

HAASS: So you’re not worried that we’ve essentially shot all the monetary arrows that were in the quiver now rather than save them for when you actually are in a recovery phase?

MALLABY: I think that’s a legitimate concern. Clearly, central banks are mostly at the zero lower bound. The Fed has already shot its 1.5-percentage-point rate cut, and that’s sort of it. You can’t go much below zero because then people will just hoard cash instead of putting their money in the bank at negative interest rates. So that’s a legitimate point.

But I think at the same time what we’re seeing already and what we’ll see more of is that central banks will become more creative about lending directly to corporations. So instead of just cutting interest rates for the economy as a whole, there will be these targeted programs to get, you know, pretty much zero-cost loans into the—into the coffers of companies that need them because they don’t have any revenues; into, you know, mortgage relief for households. So I think you can expect a wave of creativity from central banks.

And similarly, from the fiscal side, you know, U.K. has announced now a fiscal stimulus equivalent to an astonishing 10 percent of GDP. The U.S., if it manages to get it through Congress, is talking about 5 percent of GDP. These are very, very big numbers, way in excess of what happened after ’08. And so I think the fiscal side will play a stronger role now than it did last time.

HAASS: One last purely economic question. Before this crisis began the United States was running a deficit at the rate of roughly a trillion dollars a year. That’s going to look modest compared to where we’re going to be a few months from now. Do you see any problems with that? Could there be any problems facing the United States and the dollar just given the pace at which the debt is building up and the scale of the debt?

MALLABY: You know, in the long term of course a huge debt overhang is a—is a major generational inequity. Somebody will have to pay that off, and it will be the people who are young. But in the short term, I think, with interest rates being as low as they are, the cost of servicing that debt is tenable. And in the extreme, the central bank will simply buy the debt.

And so we’re in this strange world where, you know, if you think about the lesson of 2008 in terms of economic policy scope, it was the central bank could create unlimited amounts of money to throw at the financial system to stabilize it. I think what we may learn here, you know, counterintuitive though it sounds, is that there’s almost the same ability for the fiscal side. Budgets can run absolutely massive deficits so long as there’s no inflation penalty, so long as, you know, the currency isn’t collapsing. And those so-long-as conditions probably will hold for the country with the world’s reserve currency, the United States. The dollar has been strong through this because there’s always a flight to the dollar in a crisis.

The worry is going to be—and here you’re going to see a massive north-south, poor country-rich country divide—is that not only do the likes of Africa and Latin America and the Middle East have much weaker public-health systems, as Tom has been emphasizing in what he’s been writing, but they have much, much less scope for economic response because look at Argentina. You run a big government deficit in Argentina and the markets will punish you immediately. And so I think you’re going to see this big divide between rich countries which have policy space for economic response and those that don’t.

HAASS: Thank you.

One last question for Tom Bollyky and Yanzhong Huang before I open it up, which is these conversations—I don’t mean just this one, but the news we live with 24/7 now—is borderline relentlessly negative. So I’m curious. Both of you have more focus on the health side of the issue as opposed to the economic. Do you see or can you identity any things out there that you say that’s at least a bit of a piece of good news, or there’s a green shoot there, or there’s something promising there? I’d just be curious whether there’s—what you would identify, looking either at the United States or other situations, where you would say either in limiting the scale of this, fighting it, what have you that gives you some reason for a positive reaction. Tom, why don’t we begin with you?

BOLLYKY: So I—the positive I would see is after what I would characterize as a(n) extraordinarily slow response in the United States to the news of this outbreak and its potential spread, to start preparing hospitals and adopting these social-distancing policies, one might have thought you would see a more gradual rollout of the suppression policies than what we have. And I think there is something favorable to draw from for the most part, you know, over the last ten days; governments have been moving, and fairly aggressively so, in terms of adopting these policies. So I am hopeful that we start to see the benefits of that. It’ll take some time. Given how little testing we’ve had in the United States, the numbers will ramp up relatively slowly so it’ll be difficult to pick up, but I do believe and suspect we will see that the sacrifices being made now and being made so broadly will start to bear benefits in terms of reducing what I think otherwise may have been a world-beating trajectory in terms of how we experience this virus and this disease.

HAASS: Thank you.


HUANG: Yeah, I could indeed see some positive developments that—for example, that the government implementation of this mass social-distancing measures, is people seem to be cooperative, and I think give it maybe two weeks we are probably going to see the effect. And we are also seeing that there are several vaccine candidates being now—seeing this clinical trial stage, so hopefully what that—(laughs)—in one year so we’re going to see the vaccine being in place. That, I believe, is crucial to stop the spread of the virus. In the meantime, despite those social-distancing measures—I always think that is not a very good term to describe this social resilience in our society—we have been seeing people, then they learn that there is a shortage of those facial masks, the PPE, they actually indeed become more mobilized to donate into the hospitals, to health-care workers. And so that aspect of this social resilience should not be ignored in our—the fighting with that dangerous virus.

In the meantime, we are already seeing in countries like China, you know, even the economy is actually severely hit by the virus, but we are showing already substantial improvement across the country for the restaurants, you know, the convenience stores, et cetera. And so that—the capability to recover from the crisis in the society and the economy should not also—I think that kind of resilience should not be overlooked.

HAASS: OK, thank you.

OK, Ryan, why don’t we open it up, then, with questions from all those who are on the call?

OPERATOR: Thank you. At this time we will begin the question-and-answer session.

(Gives queuing instructions.)

We’ll take our first question. Caller, please go ahead.

Q: Hi. This is Nick Turse from the Intercept.

I hoped you might be able to say, what can America learn from the Chinese model of responding to COVID-19? And what lessons could be feasibly implemented here?

HAASS: Yanzhong, why don’t you take that first and then, Tom, if you want to agree or disagree, chime in?

HUANG: OK, sure. I think—well, if you actually compare the U.S. initial stage of the response to the crisis and that of China’s response, you indeed saw some parallels, that there was—well, despite the fact that there’s no coverup on the U.S. side, but you know, there is indeed we were sort of late in terms of responding to the crisis, you know, that if we were like Singapore, you know, by acting early and taking more aggressive, you know, social-distancing measures, you know, that—and also starting contact tracing of the infected people, testing everyone with the symptoms, I think we would be in much better shape.

You know, that being said, I also believe that the Chinese model probably is not replicable and maybe also should not be replicated, you know, that—for one or two reasons.

The first, the Chinese government was able to pursue this draconian approach because they had a very strong state, and that was able to penetrate society, enforce its decisions with the aid also of the high-tech knowledge. And we have seen, for example, in China the use, the high-tech means, the cellphones, the big-data to monitor people’s movements. You also have security guard on patrol for every residential areas. That, you know, kind of approach—essentially like a complete shutdown of the society and economic activities—you know, probably you don’t want to copy here in the United States.

And also, again, just as I mentioned, that the policymaking, weighing the making decision as they should also try to manage the health risk in keeping the economy and the society afloat. So you—by pursuing a(n) extreme approach to maximize protection of the health, you could also cause major panic. And then that leads to just devastating consequences on the economy and society. That is something I think a democracy should try to avoid here.

HAASS: Tom, do you have anything to add, or should we go to—I leave it to you.

BOLLYKY: Sure. I’ll just say a few things quickly.

Let’s start with the positives. I think that just from China’s example, which is when they began to respond after January 20 they began to respond with great speed. They mobilized both human and resource capacity and capacity in terms of hospital space to address the crisis. They adopted social-distancing policies such as banning public transport and public gatherings and to some degree schools, that the measures—those measures have been proven to have been effective.

Most of what China did, though, that was effective could have been done without the more draconian approach they had taken, can be done without violating human rights. And I believe with my—agree with my colleagues that no country can or should try to replicate China’s response more broadly because we can’t let the response to the latter stages of the outbreak obscure what happened earlier, because there is a difference between responding slowly and actively suppressing information about human-to-human transmission. There is difference between not publicizing the basic risk communication that may have prevented thousands of Chinese from becoming infective.

What we have started to see about traveling patterns out of Wuhan and out of other parts of China internationally suggest that a significant number of cases spread during this period. So mostly China put its own population at risk, but if that active suppression has consequences internationally. Now, that doesn’t absolve the U.S. or any other government that has moved slowly in response to this outbreak. And all governments that have moved slowly own that mistake. But we—but China’s example’s a complicated one, and we shouldn’t forget the early stages of it.

HAASS: Thank you. Ryan, let’s get the next question, please?

OPERATOR: Thank you. We’ll take our next question. Caller, please go ahead.

Q: Hi, Richard. This is Ramakrishna from the Green Climate Fund.

Thank you very much for the panel. I was just wondering if there is a comparison between this pandemic with the previous ones, in terms of the impact it has one people and economy. Thank you.

HAASS: I didn’t quite follow that. Sebastian, did you get that?

MALLABY: Well, the question is—the question about the impact of peoples and economies, comparing this pandemic with earlier ones.

Q: Yes, that is correct.

MALLABY: Yeah. Well, I mean, the Spanish flu, so-called, the 1918 influenza, is a tricky comparison between that was, you know, obviously through the end of the First World War, and so the fact that the U.S. stock market was up 10 percent that year might have more to do with peace than to do with pandemics. I’m not sure whether you’re thinking of other pandemics, but they’ve all been way, way smaller in terms of scope. So I don’t know what other examples you were thinking of.

HAASS: Well, I would actually say this is the first pandemic we’ve had since then. We’ve had outbreaks or epidemics, but this is something that’s qualitatively different both in the geographic reach and in the numbers involved, and the potential numbers in involved.

Q: Thank you.


HAASS: Why don’t we go then to—Ryan, to the next?

OPERATOR: Thank you. Again, please announce your name and affiliation before each question. We’ll take our next question. Caller, please go ahead.

Q: Hi. This is Steve Hellman from Energy Impact Partners.

A quick question. I’m sure that many of you have read Tom Friedman’s article or op-ed that references David Katz’s theory about just sequestering elderly people and then allowing herd mentality—or, herd immunity to take over. Is that a viable concept? And is it—or is it just deeply hypothetical at this point, because nobody’s going to do that? Question—and then a kind of follow-up question is when, in your mind, do we actually get back to—if we continue to pursue the sequestering process that we’ve undertaken, when do our societies—or, when does the United States get back to a quasi-normal functioning, in your view? How does this play itself out over the coming months? Thank you.

HAASS: OK, so Tom why don’t you take the first bite at that apple, and particularly the question of the, quote/unquote, “more surgical” approach that Tom Friedman and several other people have suddenly advocated in the last forty-eight hours?

BOLLYKY: So I don’t think it’s—my personal view is I don’t think it’s practical. I think our options really are social distancing policies now and moderate economic damage later, or social distancing policies too much—or, two months from now with much more significant health damage and much more significant economic damage later. I think it’s important to recognize that it is not just the elderly that are being affected by this virus. So far in the United States 20 percent of the hospitalizations that are occurring due to COVID-19 are occurring in people ages twenty to forty-four. You—it’s really anyone who has compromised health, in terms of other overlapping diseases, particularly circulatory or cardiovascular diseases, or broader suppressed immune system.

If this infects 40 to 70 percent of the population prior to having—at the same time, if we’re not able to spread it out, you really will see dramatic consequences of the nature that we’re seeing in Italy where, again, even there, you’re seeing a significant toll in terms of hospitalizations and then, in some cases, severe outcomes, including death, among younger populations. I just don’t think it’s a viable notion that we can sequester the old and let the—let the dice roll with the—with the remainder of the population. We really would suffer some rather severe health outcomes.

HAASS: Sebastian—let me ask one question of Sebastian. Is it fair to say that the British government was originally attracted to that kind of an argument, and seems to have backed off subsequently?

MALLABY: Well, there’s been some press reporting to the effect that the sort of top political advisor to the prime minister, who’s Dominic Cummings, was attracted to the idea of, you know, letting some number of pensioners die off as a price to maintain economic growth, and not have to impose a crippling cost on the economy by forcing everybody else to stay home. And then he did back off. I think one factor that, you know, complicates this whole thing is that it’s one thing to advocate social, you know, distancing for, you know, pretty self-sufficient and healthy people, you know, between the age of, say, seventy and eighty-something, whatever their individual case is.

But if you’re talking about, you know, a fragile person who’s a bit older than that, you can’t just leave them in an apartment to fend for themselves. I mean, they can’t. So families and communities somehow are going to be in contact with large numbers of elderly people because it would be completely inhumane not to be. And the social isolation, the mental health problems that you would get from pursuing that strategy aggressively would be way too high. So I think that’s—in addition to the notion that Tom raised, which is that there are plenty of people in the twenty to forty-four age bracket who might be needing hospital care, there’s also the impossibility of isolating those older people who can’t really be isolated.

HAASS: Steve, you also asked about the long term, how long are societies going to be living in this abnormal way? And I think based upon everything that I’ve heard there’s no answer to your question, because so much is dependent both about the nature of this virus—whether it recurs and so forth—and also about what steps or practices are adopted. So my—I could imagine a situation where you got different answering societies. Indeed, we’re already seeing signs of that.

Ryan, want to give us another question?

OPERATOR: Thank you. We’ll move onto our next question. Caller, please go ahead.

OPERATOR: Hi, there. Jove Oliver, senior advisor with the International Union Against TB and Lung Disease.

A lot of our folks in Africa are very concerned about the continent and its sort of preparedness. And I wanted to ask both of the global health folks, you know, how do you see this unfolding in Africa? And given the sort of lack of, like, the robust data, surveillance at peace capacity that you see there, how worrying is that both now and also as sort of Europe, and the U.S., and others contain it, for, you know, how what’s going to sort of come back again. And then just sort of related to that data question, how confident are we in the new data from China, given that, you know, there were transparency issues in the beginning? Are we—sort of do we have a high degree of confidence in the new, you know, no new cases and 80 percent manufacturing back online? Thanks.

HAASS: Let me just say—I’ll ask Tom to say what he knows about Africa and Yanzhong to say something about Chinese data. Let me just also add that probably in about two weeks, give or take, we’ll have one of our weekly regional sessions devoted to the state of play in Africa vis-à-vis the coronavirus, and how countries there are handling it. But, Tom, why don’t you go first about what you know about that—the situation on the African continent?

BOLLYKY: Yeah. So I am deeply concerned from a health care capacity standpoint. Many of the health systems, particularly in sub-Saharan Africa are dramatically underfunded. How dramatically underfunded? Well, as part of the analysis I did for my recent book we looked at the total health spending of governments in sub-Saharan Africa. And you know, people define that differently, but in terms of the forty-eight governments we looked at, collectively they spend as much as the government of Australia did for its twenty million people. So significantly underfunded.

The region is estimated by the World Health Organization to be about two million health workers short of what they would need. So that’s a significant lack of workforce. Many of the deficiencies that—in terms of surge capacity—are really going to come to bear here. You just don’t have either the equipment, or the hospital beds, or the workforce to tackle an outbreak of this nature. If you’re looking for signs of optimism, and there aren’t that many, I will say that this is one region that received significant investment as part of the Global Health Security Initiative. So there is an Africa CDC that is staffed with really hardworking, sharp people. On the country level, in countries like Nigeria, that’s certainly the same. They’re not tackling this from ground zero. But they’ll have some way to go.

The other bit of optimism, and it’s modest, you know, South Africa—I mean, sub-Saharan Africa has a high disease burden, which will complicate these issues, but it is a younger population than what we see in Italy. So if you’re looking for anything to be optimistic about, it is that. But we’re going to have a significant challenge in poorer nations in terms of the response to this outbreak—both from a health perspective and, as Sebastian rightly mentioned before, from an economic perspective.

HAASS: Thanks. Yanzhong, do you want to say something about Chinese data and what, if any, confidence we can now have in it going forward?

HUANG: Well, yeah, sure. That I think as I mentioned that China has not officially reported any new confirmed cases nationwide since March 19. And even in Wuhan, there have been no reported cases over the past five days. And it looks like the government’s encouraging people to return to work, if they do not have a temperature and could provide a green health code, certainly. So it’s—from my conversation with the people in the country, I think that the reality is they feel much safer there. Now it’s safe to say that it’s probably one of the now safest in the world. But according to a quasi-independent newspaper, Taisheng (ph), that there are still a few dozen people who are not showing symptoms testing positive every day in Wuhan that was not included in the official government report. In the meantime, the government is facing growing challenges of these imported cases. They have not included also—they created actually a separated dataset for this group of imported cases.

HAASS: Thank you. OK, Ryan, let’s get the next question, please.

OPERATOR: We’ll take our next question. Caller, please go ahead.

Q: Hi. My name is Emerita Torres. I’m with the Soufan Center in New York.

And just in your take—related to what’s happening in Africa, just some of the humanitarian issues that we’ll face in countries of conflict, just given, you know, today we had our first case in Syria, and thinking about Yemen, and Libya, DRC, CAR, countries that are facing conflict. How does the international community, human rights organizations, humanitarian organizations come together on this? Thank you.

HAASS: Tom, you want to take a quick crack at that?

BOLLYKY: You know, it’s an area where I think we would rightly have grave concern. The humanitarian response to refugee populations or displaced persons, both in Yemen, and Syria, and in the region, has been underwhelming overall. Many of the—as some of the listeners may know, we have the world record now in terms of the numbers of internally displaced people. Many of them have been—have been living in refugee camps for five years or more, so for an extended period of time. These populations are crowded together. Social distancing is not going to be an option for these populations. And we already were woefully underfunded in providing for their health care needs, both in terms of infectious diseases as well as the underlying burden of heart disease, diabetes, chronic diseases as well.

If people want to look for a glimmer of hope on this, it’s that there is a greater degree of self-interest for the world in terms of controlling the spread of this virus within those communities, as it does provide a reservoir of cases that can continually potentially re-infect other nations that have managed to get these disease under control. And maybe that will be the motivation to see a more full humanitarian response to the health care needs of these populations. But I do think we need to temper that optimism by what we’ve seen over the last several years on refugee health.

HAASS: Yeah, I would agree. I would think the world hasn’t shown much willingness in places like Idlib to do much to begin with. The other great refugee population is in our own hemisphere as a result of Venezuela. And I just think that local countries who are already straining, shall we say, to deal with the burden, this is just going to make it that much worse.

Ryan, we got time for one last question and set of answers. So over to you, sir. Hello? Ryan, can we get one more question?

OPERATOR: Yes. We’ll take our next question. Caller, please go ahead.

Q: Hi. This is Tom Mahoney from Tangent Capital.

Yanzhong, I wanted to go back to a point you made earlier on the epidemiology front about the progress, or imminent progress we all hope, towards a vaccine. Well, that’s probably, as we know, with clinical trials and testing, eighteen months or something before it would generally available. That has led to obviously a great deal of research and emphasis by biopharmaceutical companies on the antiviral front. Is there anything that you’re hearing in your role at the Council on the public health side that suggests that there’s anything—any near-term candidates that we can be optimistic about, whether it’s the hydroxychloroquine and azithromycin combination therapy that has been proposed by some French researchers, or otherwise?

HAASS: Yanzhong, why don’t want you start, and then we’ll ask Tom to chime in.

HUANG: Sure. Yeah, to my knowledge I think thus far the most—the promising antiviral kind of remains remdesivir, that’s from Gilead. You know, and even though they are—I think the U.S.—President Trump has been promoting these two types of antiviral, including the anti-malaria drug, there’s no, I think, evidence to support actually its effective against the virus.


BOLLYKY: Yeah. I would agree. Remdesivir is the candidate I think most people are most hopeful for. I will also use the opportunity to concur with Yanzhong. If you want to look at part of the system that worked well in response to this outbreak, it is the development of vaccines, antivirals, and countermeasures, which really sprung into action almost immediately in terms of when we saw this outbreak in China. So if you want to praise one part of the system that did respond well, that is the part that did.

HAASS: It is 2:00 here on the East Coast, so one of the very few principles we try to maintain at the Council on Foreign Relations is to start and end things on time. So I want to thank my three colleagues. I want to thank Tom Bollyky, Yanzhong Huang, and Sebastian Mallaby, not just for today for the last hour, but for all the work they do with us and for us not just during times of crisis but more broadly.

And I want to thank you all for joining us for this hour. As I said, we’ve got another call scheduled for Wednesday afternoon on—I think 2 p.m.—on the situation in Europe, where we’ll drill down on Italy, the U.K., and other countries. We then may have another call later in the week about leadership issues. And again, we’ll have a full menu of calls for the weeks to come.

So, Ryan, over to you to end this.


In which case I’ll end this. So again, thank you all for joining us. And again, we will inform you about forthcoming calls in—as this unfolds. I hope everyone is safe and well had has a—has a good day.


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